Provider Demographics
NPI:1588845259
Name:NEPHROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-334-9564
Mailing Address - Street 1:1349 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1727
Mailing Address - Country:US
Mailing Address - Phone:573-334-9564
Mailing Address - Fax:573-334-1879
Practice Address - Street 1:1409 E MOULTRIE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-6855
Practice Address - Country:US
Practice Address - Phone:870-776-1464
Practice Address - Fax:870-776-1474
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEPHROLOGY ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO117672OtherBLUE CROSS BLUE SHIELD
CI5170OtherRAIL ROAD MEDICARE
H8238OtherHEALTHLINK
AR5C446OtherBLUE CROSS BLUE SHIELD
H8238OtherHEALTHLINK